Step 1 of 1

Merchant Funding Application

Complete the form below. All information is encrypted and securely stored.

BUSINESS INFORMATION

Legal Corporate Name *

DBA Name

Physical Address *

City *

State *

ZIP Code *

Mailing address is same as physical address

Mailing Address

City

State

ZIP Code

Business Phone *

Entity Type *

Business Category *

State of Incorporation

Business Established Date

EIN / Tax ID *

Length of Ownership

Current Business Debt Owed ($)

Gross Annual Sales ($) *

Funding Amount Requested ($) *

Use of Funds *

Product or Service Provided

MERCHANT INFORMATION — APPLICANT 1

Full Legal Name *

Social Security Number *

Date of Birth *

Home Address *

City *

State *

ZIP Code *

Phone Number *

Email Address *

Ownership Percentage (%) *

FICO Score

MERCHANT INFORMATION — APPLICANT 2

Full Legal Name

Social Security Number

Date of Birth

Home Address

City

State

ZIP Code

Phone Number

Email Address

Ownership Percentage (%)

FICO Score

AUTHORIZATION & E-SIGNATURE CONSENT

By checking the box below and submitting this application, I/we authorize Funded Financial Network LLC and its affiliated lenders and partners to: (1) obtain consumer and business credit reports; (2) verify all information provided; (3) contact me/us by phone, email, or text regarding this application; and (4) share this application with funding partners in its network for the purpose of obtaining funding offers.

I/we certify under penalty of perjury that all information provided is true, accurate, and complete. I/we understand this is not a commitment to fund, and that all funding is subject to approval and final underwriting review.

By checking the box below I consent to the use of electronic signatures (e-signatures) via SignWell for this application and any associated agreements, which carry the same legal weight as a handwritten signature under the Electronic Signatures in Global and National Commerce Act (ESIGN) and applicable state laws.

I agree to the Terms of Service and Privacy Policy, and I consent to the use of electronic signatures for this application. *

Your information is encrypted and securely transmitted.

Merchant Funding Application

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Merchant Funding Application

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Tell us a bit about your business

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